前纵隔弥漫大B细胞淋巴瘤与胸腺癌的CT特征对比分析  

Comparative analysis of CT features of diffuse large B-cell lymphoma in the anterior mediastinum and thymic carcinoma

作　　者：郑钊文 段晓蓓[1] 林茵 陈小娟 聂中新 陈相猛[1] ZHENG Zhao-wen;DUAN Xiao-bei;LIN Yin;CHEN Xiao-juan;NIE Zhong-xin;CHEN Xiang-meng(Jiangmen Central Hospital,Jiangmen Guangdong 529030,China)

机构地区：[1]江门市中心医院,广东江门529030

出　　处：《中国临床医学影像杂志》2025年第2期104-108,共5页Journal of China Clinic Medical Imaging

基　　金：国家自然科学基金面上项目(62176104);北京医学奖励基金(YXJL-2023-0866-0324)。

摘　　要：目的:对比分析前纵隔弥漫大B细胞淋巴瘤(DLBCL)与胸腺癌的CT特征,提高对两者的鉴别诊断能力。方法:回顾性收集本院2009年4月—2023年2月经手术切除/穿刺活检且病理组织学证实为前纵隔DLBCL和胸腺癌的患者共48例。男19例,女29例,年龄17~81岁,中位年龄53.0岁(Q1:36.0;Q3:61.8)。所有病例在病理确诊前均行胸部CT平扫及增强检查。阅读CT征象包括病灶部位、形态、边缘、密度、强化程度、周围侵犯、坏死区域面积和交界面等。采用两组独立样本t检验或Mann-whitney U秩和检验、卡方检验或Fisher’s精确检验对比分析两者的CT征象之间的差异。结果:共纳入前纵隔DLBCL患者18例,男4例,女14例;年龄17~81岁,中位年龄35.5岁(Q1:29.0;Q3:50.3),胸腺癌患者30例,男15例,女15例;年龄19~71岁,中位年龄57.0岁(Q1:51.5;Q3:64.5)。两组在跨越中线、病灶形态、侵犯周围结构的差异无统计学意义(P=0.052;P=0.215;P=0.582);包绕纵隔大血管、胸膜增厚、胸腔积液的差异具有统计学意义(P=0.003;P=0.011;P=0.017)。76.7%(23/30)胸腺癌和88.9%(16/18)DLBCL表现为不均匀强化(P=0.294);胸腺癌内部钙化、明显强化的数量高于DLBCL(P=0.005;P<0.001)。两组在内部坏死、坏死区域占比间的差异无统计学意义(P=0.199;P=0.063);50%(8/16)DLBCL坏死区交界面清晰呈“假性囊腔征”,明显高于胸腺癌组13.6%(3/22)(P=0.012)。结论:前纵隔DLBCL与胸腺癌在MSCT上具有特征性表现。DLBCL较多出现跨区生长、血管包绕和“假性囊腔征”,胸腺癌经常发生胸膜侵犯、内部钙化和明显强化,上述胸部MSCT征象有助于两者的鉴别诊断。Objective:To compare and analyze the CT characteristics of diffuse large B cell lymphoma(DLBCL)and thymic carcinoma in order to improve the differential diagnostic ability between the two diseases.Methods:Forty-eight patients(19 males,29 females;age range 17~81 years,median age 53.0 years(Q1:36.0;Q3:61.8))with anterior mediastinal DLBCL and thymic carcinoma confirmed by surgical resection or biopsy with pathological diagnosis were retrospectively collected from April 2009 to February 2023 in our hospital.All cases underwent chest CT plain and enhanced examinations before pathological confirmation.CT findings including lesion location,morphology,margins,density,degree of enhancement,surrounding invasion,necrosis area were reviewed respectively.Statistical analysis was carried out to compare the CT features of the two groups.Results:A total of 18 cases of anterior mediastinal DLBCL(4 males,14 females;age range 17~81 years,median age 35.5 years(Q1:29.0;Q3:50.3))and 30 cases of thymic carcinoma(15 males,15 females;age range 19~71 years,57.0years(Q1:51.5;Q3:64.5))were included.There was no statistically significant difference between the two groups in midlinecrossing,lesion morphology,and invasion of adjacent structures(P=0.052;P=0.215;P=0.582).The differences in mediastinal vascular wrapping,pleural thickening,and pleural effusion were statistically significant(P=0.003;P=0.011;P=0.017).76.7%(23/30)of thymic carcinomas and 88.9%(16/18)of DLBCL showed heterogeneous enhancement(P=0.294).The thymic carcinomas exhibited more internal calcification and significant enhancement compared to DLBCL(P=0.005;P<0.001).There was no statistically significant difference between the two groups in terms of internal necrosis and the proportion of necrotic areas(P=0.199;P=0.063);the clear demarcation of necrotic areas as“pseudo-cystic sign”was observed in 50%(8/16)of DLBCL cases,significantly higher than 13.6%(3/22)in the thymic carcinoma group(P=0.012).Conclusion:Anterior mediastinal DLBCL and thymic carcinoma both exhibit character

关 键 词：淋巴瘤 大B细胞 弥漫性 胸腺肿瘤 体层摄影术 螺旋计算机 

分 类 号：R733.4[医药卫生—肿瘤] R736.3[医药卫生—临床医学] R814.42